Dr. Nagler's Tinnitus Corner
Sign up Latest Topics
 
 
 


Reply
  Author   Comment  
Steve

Member
Registered:
Posts: 21
 #1 
Hello Dr Nagler ,

I posted awhile about the ED drug Levitra , it worked as intended but besides spiking my tinnitus (temporary) it also gave me bad headaches .

I discussed this with my urologist and he decided to prescribe me Avanafil (Spedra) as that was supposed to give less side-effects and is generally better tolerated .

So last night, almost 24 hours ago I took just a small dose of 50 mg, the recomended minimal dose , I cut the 200mg tablet in 4 and my tinnitus turned into a roar , very worried about this as it is incredibly loud atm and I could not sleep even with aids in the form of some clonazepam . It still is roaring the next day . I do not feel like I have sudden hearing loss , just much increased tinnitus .

I tought you said previously that these type of drugs are not ototoxic or harmfull to the ear , what is causing this unacceptable increase ?

I contacted my ENT doctor and he said I could start a Medrol course and stop the drug immediatly.

I feel very guilty of taking this drug but I pretty much need it if I want to have a sex life :-(

Please advice and give your opinion on this matter . Is there a chance that this is just a temporary adverse reaction and will clear up in a few days ?

Thanks


Dr. Nagler

Owner
Registered:
Posts: 1,599
 #2 
Quote:
Originally Posted by Steve
I tought you said previously that these type of drugs are not ototoxic or harmfull to the ear , what is causing this unacceptable increase ?

How loud a sound sounds at any given time is related to the strength of the signal at its origin as well as the effect of the pathways along which that signal must travel between its place of origin and the auditory cortex, where it is actually perceived. Here is a very simplistic example. Take a wind-up clock that many of us fossils will recall from the 1950s and 1960s. They look like THIS. You would wind it up once a day, and the last thing you would do before falling asleep would be to listen for the very soft ticking to be sure it was running. Now imagine the exact same scenario, but the windows of your bedroom room are nailed shut, the door is bolted from the outside, and you are informed that the clock is actually the timing mechanism on a bomb. Well now all your focus is on the clock as you try to find some way to escape. And the ticking? The ticking now sounds absolutely thunderous - even though in dB it is no different than it was when you had to purposely listen for it after you wound up that little alarm clock each night. And the same sort of thing holds true for tinnitus!

Levitra and similar drugs in that class have been rarely associated with sudden hearing loss and tinnitus. But the mechanism has never been determined, nor can anyone say whether or not there is a true causal relationship to begin with. In terms of your tinnitus, I would want to know your baseline loudness match in dB as well as your loudness match when you noticed the increase in intensity before I said with 100% certainty that some pharmacological effect of the drug caused a change in the strength of your tinnitus signal itself.

Quote:
I contacted my ENT doctor and he said I could start a Medrol course and stop the drug immediatly.

Sounds like a very wise recommendation to me. Your ENT does not need to know anything with 100% certainty. If there's a chance that it's the drug, he should do exactly what he did! Smart fellow, your ENT.

Quote:
I feel very guilty of taking this drug

You took some very reasonable precautions and experienced what might (or might not) be an adverse reaction. What's to feel guilty about? Sounds to me like very responsible behavior.

Quote:
but I pretty much need it if I want to have a sex life :-(

Nonsense. If your doctor suggests that you stay away from any and all PED5 inhibitors, there are many other approaches available for symptoms of erectile dysfunction. Hell, if push comes to shove (no pun there) you can even have a completely concealed implantable pump placed surgically that will allow you to have an erection on demand and maintain it for as long as desired (even post-orgasm!) before pressing the release button located under your skin. Your partner will think you are Hercules! :-)

Seriously, this unpleasant experience with the avanafil (if it was the avanafil) is little more than a blip on your radar screen. It just seems catastrophic in the moment.

Quote:
Please advice and give your opinion on this matter.

Done

Quote:
Is there a chance that this is just a temporary adverse reaction and will clear up in a few days ?

Absolutely! There is an excellent chance. In fact, I'm not even so sure it's an adverse reaction. Might just be the product of worry and concern. 

All the best -

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Steve

Member
Registered:
Posts: 21
 #3 
Quote:
Seriously, this unpleasant experience with the avanafil (if it was the avanafil) is little more than a blip on your radar screen. It just seems catastrophic in the moment.


If this volume does not return to my mild to moderate base level I do not think I will ever see this as a blip , it is is easily 10 out of 10 in volume .

Quote:
You took some very reasonable precautions and experienced what might (or might not) be an adverse reaction


I do not feel like it , I should not have taken the drug , even if there was a small chance that it muight be damaging to my ears , but I trust these pill pushers who prescribe this rubbish without a second tought , one small little pill might have potentially ruined my quality of life , I could have easily avoided it if I insisted on alternatives, or even tried natural remedies first .

Quote:
Absolutely! There is an excellent chance. In fact, I'm not even so sure it's an adverse reaction


I am not sure if you really believe this or if you just say this to comfort me but I will hold on that tought , and maybe , hopefully it will settle back down a couple of notches after a couple of days, hopefully , how long can these things usually last ? I read somewhere that it can take up to 2 weeks to settle back down .

Thanks .
Dr. Nagler

Owner
Registered:
Posts: 1,599
 #4 
Steve, I absolutely understand the extent of your distress. And you are obviously extremely upset, which serves to compound the problem - because anxiety often feeds the fires of tinnitus and can make it sound louder than it actually is! Anyway, if you would like to discuss your situation in more depth, I would be happy to do so off the board. Perhaps it will help alleviate some of your concerns.

One thing, though. Towards the end of your post above, you wondered if when I wrote that there was an excellent chance that your tinnitus would settle back down, I said it because I believed it or I said it just to comfort you. So let me clarify. I never say things on this board (or elsewhere, for that matter) unless I believe them to be accurate. I do not say things that are untrue merely to provide comfort. It's just not who I am.

Now, in terms of when your tinnitus might settle back down. please please please don't put some sort of calendar on it. That's about the worst thing you can do!

All the best -

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Steve

Member
Registered:
Posts: 21
 #5 
Thank you Dr Nagler for your support , it really means alot to me .


I had another appointment today with a professor from the ENT department at the hospital , and we discussed my situation and my concerns about PDE5 inhibitor class drugs .

His personal opinion is that people who allready have tinnitus should be very cautious about these drugs , as you also mentioned the exact mechanism is unclear but he strongly believes sudden changes in blood pressure and vasolidation can play a role and trigger an exarcebation or damage the inner ear or nerves .

I am taking Medrol (corticosteroids) for 9 days and it seems to tak the edge of it somewhat , although it is still louder and fluctuating , he advised me to finish the 9 day course and is positive that the volume should come down to previous levels , although it is impossible to say with 100% certainty , I am suppose to see him again in 4 weeks to evaluate and do a full check up .


Dr. Nagler

Owner
Registered:
Posts: 1,599
 #6 
Quote:
Originally Posted by Steve
Thank you Dr Nagler for your support , it really means alot to me .

Glad to help.

Quote:
I had another appointment today with a professor from the ENT department at the hospital , and we discussed my situation and my concerns about PDE5 inhibitor class drugs .

His personal opinion is that people who allready have tinnitus should be very cautious about these drugs , as you also mentioned the exact mechanism is unclear but he strongly believes sudden changes in blood pressure and vasolidation can play a role and trigger an exarcebation or damage the inner ear or nerves .

So now we are headed more towards discussion than Q&A, which is something I really try to avoid on this board. But let me just say that there are some very good data (dating as far back as 1953) that suggest that everybody has tinnitus. In other words, the problem is one of loudness, awareness, and its effect on the individual rather than whether or not any given individual has it - because we all have it to some degree or other (or so the data suggest). And that being the case, I'm not exactly sure where one draws the line with respect to PDE5 inhibitors, etc.

Just something to add to the mix.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.



Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.